Kids and vitamins: what parents need to be aware of

By Dee Madore, R.D.

According to the American Academy of Pediatricians (AAP), "Supplemental vitamins are expensive and probably unnecessary for the healthy child who consumes a varied diet."

So you may ask yourself, does my child consume a varied, well-balanced diet? To find out, visit MyPyramid.gov and click on My Pyramid Plan. Enter your child's age, sex and activity level and find out how his or her diet stacks up.

If your child's diet meets these guidelines, or could with some adjustments, he or she probably does not need a supplement.

Many parents feel that despite eating a well-balanced diet, the multivitamin either won't hurt or actually may help to keep their child from getting sick. It is true that if the supplement contains vitamins and minerals at the level of the recommended dietary allowances, it probably does no harm when given to the child on a daily basis. However, there is no known benefit of extra doses of vitamins in preventing colds.

When might supplements be needed?

Vitamin D: The AAP recommends a supplement of 200 IU/d of Vitamin D for all breastfed infants. Non-breastfed infants and children who do not get regular sunlight exposure or have a low intake of vitamin D fortified formula or milk also need a supplement.

Iron: Full-term breastfed infants need a supplemental source of iron starting at 4-6 months of age. The iron should preferably come from infant cereal; an average of 2 servings (1/2 oz. of dry cereal per serving) is needed. Iron drops should be used if the infant is unable to consume enough iron from the diet.

For infants on formula, only iron-fortified formula should be used during the first year of life. For young children ages 1-5, avoid a milk intake of greater than 3 cups per day since this can lead to iron deficiency by taking the place of iron-rich foods.

Children in their second year may need a daily multivitamin with iron, especially if there is a lack of meat-based iron in the diet. However, 4 oz. of YoBaby Plus Cereal Yogurt or ? cup of Cheerios or 1 packet of Cream of Wheat will meet your toddler's daily iron needs. Children who consume a vegetarian diet and adolescent females who are not receiving an iron supplement should be screened for anemia.

Fluoride: Exclusively breastfed infants over the age of 6 months and children up to age 16 years may need a fluoride supplement depending on the fluoride concentration in the local water supply. 

At-risk children: Groups that may need supplements are: premature infants, children from deprived families, children with poor appetites and limited intakes, infants and children with malabsorption or chronic disease such as cystic fibrosis, inflammatory bowel disease, renal or liver disease, children on fad diets or restricted diets to manage obesity and pregnant teens.

Can my child be getting too many vitamins?

Yes. A recent dietary intake survey of infants and toddlers 4-24 months found that nearly all toddlers who used supplements had intakes above the tolerable upper intake level for vitamin A, about two-thirds were above the tolerable upper limit for zinc and nearly one-fifth were above the upper limit for folate. Use of vitamin and mineral supplements may increase the risk of toxicity. 

Whole foods versus supplements

It is clear that getting your vitamins and minerals from a variety of whole foods is the best way to go. It has been shown that supplementation of specific nutrients does not have the same health-enhancing effect as consuming whole foods naturally rich in these nutrients. Whole foods are complex structures containing a variety of factors that work together to allow vitamins and minerals to work in your body. When isolated from the whole food, some of these nutrients will not work as well.

So many supplements, which one to choose?

If you and your child's health care provider decide that supplements could benefit your child, it may be difficult to decide which one to use.

Children's multivitamins come in a variety of forms. They are available in liquid, powder, capsule, chewable, gummies, gumballs and dissolvable strips. Not all vitamin supplements are created equal. Many only contain individual or select vitamins and minerals, while the complete supplements contain virtually all vitamins and minerals.

The flavored vitamins in candy form may be more palatable for children; however, these forms may not contain the nutrients your child may need. It is also important that these tasty vitamins are consumed only in the dose recommended on the label to prevent toxicity.

Be aware that vitamin preparations for infants and children younger than 4 years old are regulated by the FDA, but preparations for older children and adults are not subject to the regulations of the FDA. It is wise to ask your child's pediatrician, dietitian or pharmacist if you are unsure about a particular product.